Psychodynamic Traumatherapy of Refugees with PTSD and Somatisation [Stabilisierende psychodynamische Traumatherapie für Flüchtlinge: Ein Leitfaden für das therapeutische Vorgehen bei PTBS und Somatisierung]
Joksimovic L.,Klinik fur Psychosomatische Medizin und Psychotherapie |
Kruse J.,Universitatsklinikum Giessen und Marburg GmbH
PPmP Psychotherapie Psychosomatik Medizinische Psychologie | Year: 2016
The medical care of refugees and asylum seekers requires culturally sensitive and diverse structuring of the healthcare. In the psychotherapeutic and psychosomatic treatment of these patients the culture-specific and social aspects and also the high ratio of patients with post traumatic stress disorders and somatoform disorders have to be considered. The principles of stabilizing psychodynamic traumatherapie of refugees will be introduced, which efficacy was determined by controlled study. The specific adaptations of the trauma-orientated psychotherapy to the specific situation of refugees and asylum seekers will be described. Copyright © 2016, Georg Thieme Verlag. All rights reserved.
Steiss J.O.,Universitatsklinikum Giessen und Marburg GmbH
Atemwegs- und Lungenkrankheiten | Year: 2017
Among the most common causes of chronic cough are bronchial asthma and post-infectious cough. However, many other differential diagnoses must be considered. Of primary importance for the diagnosis are the characteristics of the cough, the medical history, and findings from the clinical examination, as well as the lung function and chest X-ray results. The treatment for cough will depend on the underlying disorder. Few evidence-based studies are available on the efficacy of symptomatic drug treatment in children. Due to the frequency with which children present in the doctor's office with cough, there is a risk that the few patients with underlying diseases will be overlooked. © 2017 Dustri-Verlag Dr. Karl Feistle.
Van Dijk K.,Netherlands Institute for Innovative Ocular Surgery |
Droutsas K.,Netherlands Institute for Innovative Ocular Surgery |
Droutsas K.,Universitatsklinikum Giessen und Marburg GmbH |
Hou J.,Netherlands Institute for Innovative Ocular Surgery |
And 3 more authors.
American Journal of Ophthalmology | Year: 2014
Purpose To evaluate corneal higher-order aberrations (HOAs) and backscattered light before and after Descemet membrane endothelial keratoplasty (DMEK) and their correlation with visual outcome. Design Retrospective study. Methods In a total of 118 consecutive eyes of 118 patients who underwent uneventful DMEK for Fuchs endothelial dystrophy at a tertiary referral center, best spectacle-corrected visual acuity (BSCVA), corneal HOAs, and backscattered light were evaluated preoperatively and at 6 months postoperatively. Outcome data were compared to an age-matched control group with uncomplicated eyes (n = 27). Results Compared to the control group, Fuchs endothelial dystrophy eyes, before as well as 6 months after DMEK, showed higher values of anterior and posterior HOAs and backscattered light (P <.033). Postoperative anterior HOAs and backscattered light (0-2 mm) were associated with lower 6-month BSCVA (positively related with logMAR BSCVA) (P ≤.020). Anterior corneal HOAs did not change from preoperative to 6 months after DMEK (P =.649), while total posterior HOAs (RMS third to sixth Zernike order) and haze decreased (P <.001). Conclusions Anterior and posterior corneal HOAs, as well as backscattered light from the cornea, were elevated in eyes suffering from Fuchs endothelial dystrophy and remained higher throughout 6 months after DMEK. If present, anterior surface irregularities and anterior corneal haze may be the most important limiting factors in visual rehabilitation after DMEK. © 2014 by Elsevier Inc. All rights reserved.
Neumann-Silkow H.,University of Marburg |
Gorg C.,Universitatsklinikum Giessen und Marburg GmbH
RoFo Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgebenden Verfahren | Year: 2010
Purpose: Recent studies have reported high accuracy of power Doppler sonography (PDS) and color Doppler sonography (CDS) in the differentiation of benign and malignant peripheral superficial lymphadenopathy. This study was conducted to determine whether PDS can differentiate benign from malignant abdominal lymph nodes on the basis of defined vascular patterns. Materials and Methods: We retrospectively evaluated 88 color pictures of abdominal lymph nodes (39 benign lymph nodes, 24 malignant lymphomas, 25 lymph node metastasis) done in the power Doppler mode. The goal was to determine whether benign and malignant abdominal lymph nodes can be differentiated in power Doppler sonography on the basis of 9 defined vascular patterns. Results: Three vascular patterns showed a significantly (p < 0.05) higher appearance in malignant than in benign lymph nodes: aberrant vessel (specificity 87 %), avascular focus (specificity 92 %) and subcapsular vessel (specificity 100 %). The vascular pattern hiliar vessel showed a significantly higher appearance in benign lymph nodes (specificity 87.8 %). Conclusion: Three vascular patterns are detectable in power Doppler mode (avascular focus, aberrant vessel, subcapsular vessel) in abdominal lymph nodes, which are typical for malignant abdominal lymphadenopathy. The presence of one of these vascular patterns means with a high specificity (87 100 %) that an abdominal lymphadenopathy is malignant. One vascular pattern (hiliar vessel) shows a significantly higher appearance in benign lymph nodes. © Georg Thieme Verlag KG Stuttgart New York.
Horn E.-P.,Klinik fur Anasthesiologie |
Torossian A.,Universitatsklinikum Giessen und Marburg GmbH
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie | Year: 2010
Inadvertent perioperative hypothermia impairs postoperative outcome in surgical patients due to ischemic myocardial events, wound infections and coagulation disorders. Body core temperature should be assessed 12h preoperatively and continuously during surgery. To prevent hypothermia patients and nursing clinical staff should be teached and trained. Preoperatively surgical patients should always be prewarmed by using convective warming devices and active warming should be continued in surgeries longer than 1 hour. Warming of IV fluids is effective if infusion rates are above 1l/h. Core temperature should be measured in the recovery room and active warming should be started when patients are hypothermic or if they feel cold. © Georg Thieme Verlag KG Stuttgart New York.
Kraus R.,Universitatsklinikum Giessen und Marburg GmbH |
Wessel L.,Universitatsmedizin Mannheim
Deutsches Arzteblatt | Year: 2010
Background: The treatment of fractures in children and adolescents must be based on an adequate knowledge of the physiology of the growing skeleton. Treatment failures usually do not result from technical deficiencies, but rather from a misunderstanding of the special considerations applying to the treatment of fractures in this age group. Methods: We selectively reviewed recent publications on the main types of long bone fracture occurring in the period of skeletal development. Results: Alleviating pain is the first step in fracture management, and due attention must be paid to any evidence of child abuse. The goals of treatment are to bring about healing of the fracture and to preserve the function of the wounded limb. The growth that has yet to take place over the remaining period of skeletal development also has to be considered. Predicting the growth pattern of fractured bones is a basic task of the pediatric traumatologist. During the period of skeletal development, conservative and surgical treatments are used in complementary fashion. Particular expertise is needed to deal with fractures around the elbow, especially supracondylar humeral fractures, displaced fractures of the radial condyle of the humerus, radial neck fractures, and radial head dislocations (Monteggia lesions). These problems account for a large fraction of the avoidable cases of faulty fracture healing leading to functional impairment in children and adolescents. Conclusion: The main requirements for the proper treatment of fractures in children and adolescents are the immediate alleviation of pain and the provision of effective treatment (either in the hospital or on an outpatient basis) to ensure the best possible outcome, while the associated costs and effort is kept to a minimum. Further important goals are a rapid recovery of mobility and the avoidance of late complications, such as restriction of the range of motion or growth disorders of the fractured bone. To achieve these goals, the treating physician should have the necessary expertise in all of the applicable conservative and surgical treatment methods and should be able to apply them for the proper indications.
Torossian A.,Universitatsklinikum Giessen und Marburg GmbH
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie | Year: 2013
Perioperative temperature monitoring is a pre-requisite for successful prevention of inadvertent hypothermia in children. To achive this goal, besides of prewarming, active warming measures have to be intensified the younger and immature infants are. Intraoperatively incubators can be used. Forced-air warming in combination with fluid warming has been proven effective in children. Postoperative shivering should be treated, e.g. with pethidin or clonidine.
Eming R.,Universitatsklinikum Giessen und Marburg GmbH
Hautarzt | Year: 2015
Background: Pemphigus is a severe bullous autoimmune dermatosis that represents a clinical challenge despite high-dose immunosuppressive therapy due to the therapy-related comorbidities and the lack of long-term control of disease activity. Objectives: Which targeted therapies are currently used in pemphigus and which innovative therapeutic strategies are in clinical development? Materials and methods: A review of the literature in PubMed was performed under consideration of the current guideline for the treatment of pemphigus as well as of our own results. Discussion of basic findings and results of targeted therapies in autoantibody-mediated autoimmune disorders were taken into account. Results: Immunapheresis and high-dose intravenous immunoglobulins with the aim of reducing circulating autoantibodies have been successfully used in the treatment of pemphigus. Depletion of autoreactive B-lymphocytes provides the rationale for the use of the monoclonal anti-CD20 antibody rituximab which demonstrated long-term clinical remission of pemphigus in clinical trials. Current developments include the investigation of humanised B-cell depleting antibodies in other B-cell driven autoimmune disorders as well as the identification of new cellular and molecular target structures that are essential in the humoral autoimmune cascade and exert important immune regulatory functions, respectively. Conclusions: The well-characterised basic pathogenesis of pemphigus results in targeted therapies. Currently, therapies aiming at rapid reduction of circulating autoantibodies and the depletion of autoreactive B-cells are in clinical use. More cellular and molecular target structures are being investigated in other autoantibody-driven autoimmune disorders and they provide promising candidates for innovative pathogenesis-related therapeutic strategies in pemphigus in the future. © 2015, Springer-Verlag Berlin Heidelberg.
Burk K.,Universitatsklinikum Giessen und Marburg GmbH
Journal fur Neurologie, Neurochirurgie und Psychiatrie | Year: 2015
Disorders affecting the cerebellum and/or the spinal cord may result in chronic progressive ataxia. Imaging studies help exclude vascular or space-occupying lesions within the posterior fossa. Apart from genetic disorders, various physical, toxic, metabolic, and inflammatory mechanisms may cause symptomatic ataxia. Therefore, thorough history-taking reveals physical or chemical noxious agents. Diagnosis of hypovitaminosis can be established by means of appropriate blood tests. CSF analysis is required in patients without established genetic etiology. Immune-mediated mechanisms not only occur in infectious disease but may also cause paraneoplastic cerebellar degeneration. After exclusion of hereditary and symptomatic causes, diagnosis of "idiopathic late-onset cer-ebellar ataxia" (ILOCA) is established. ILOCA may evolve into the cerebellar variant of multiple-system atrophy (MSA-C) that is characterized by a better prognosis than its striatonigral variant (MSA-P). Therapeutic options are mostly limited to speech, physical, and occupational therapy.
Kraus R.,Universitatsklinikum Giessen und Marburg GmbH
Zeitschrift für Orthopädie und Unfallchirurgie | Year: 2012
Lawn mower injuries in children usually involve the lower extremities and can lead to serious amputation injuries. Treatment should look not only at the acute reconstruction, but also on maintaining the ability to grow. We report the case of a two-year-old boy with amputation of the heel. The boy was run over by a lawn mower. He suffered a complete loss of heel soft tissue, 30 % of the os calcis and the Achilles tendon. The one-stage reconstruction was performed by transplantation of an iliac crest graft, fascia lata to reconstruct the Achilles tendon and a microvascular latissimus dorsi flap. After one year, the functional and cosmetic result is excellent, the bone graft is healed completely and shows growth trends. The successful treatment of such a severe amputation injury requires the interdisciplinary cooperation between paediatric traumatologists, plastic surgeons, physical therapists and orthopaedic shoemaker. The result justifies the great effort. © Georg Thieme Verlag KG Stuttgart · New York.